Provider Demographics
NPI:1528253713
Name:ANDERSON, CARRIE L (FNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N ED CAREY DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7912
Mailing Address - Country:US
Mailing Address - Phone:956-428-4868
Mailing Address - Fax:956-622-3176
Practice Address - Street 1:626 N ED CAREY DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7912
Practice Address - Country:US
Practice Address - Phone:956-428-4868
Practice Address - Fax:956-622-3176
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX690906363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193290701Medicaid
TX8Y5000OtherBCBSTX
TX8K8360Medicare PIN
TX8L3431Medicare PIN